This story begins, as many do, with a real-world experience. Our health plan just refused to pay for a sleep study for my husband, who suffers from severe sleep apnea, despite his being quite symptomatic. We’re following up with the Virginia Department of Insurance and fully expect to win the day, though we remain baffled as to how they could make such a decision. While beginning the complaint process, a thought occurred to me.

What if wearables were able to detect wakefulness and sleepiness, and my husband was being tracked 24 hours a day? If so, assuming he was wearing one, wouldn’t it be harder for a health plan to deny him the test he needed? After all, it wouldn’t be the word of one doctor versus the word of another, it would be a raft of data plus his sleep doctor’s opinion going up against the health plan’s physician reviewer.

Now, I realize this is a big leap in several ways.

For one thing, today doctors are very skeptical about the value generated by patient-controlled smartphone apps and wearables. According to a recent survey by market research firm MedPanel, in fact, only 15% of doctors surveyed see wearables of health apps as tools patients can use to get better. Until more physicians get on board, it seems unlikely that device makers will take this market seriously and nudge it into full clinical respectability.

Also, data generated by apps and wearables is seldom organized in a form that can be accessed easily by clinicians, much less uploaded to EMRs or shared with health insurers. Tools like Apple HealthKit, which can move such data into EMRs, should address this issue over time, but at present a lack of wearable/app data interoperability is a major stumbling block to leveraging that data.

And then there’s the tech issues. In the world I’m envisioning, wearables and health apps would merge with remote monitoring technologies, with the data they generate becoming as important to doctors as it is to patients. But neither smartphone apps nor wearables are equipped for this task as things stand.

And finally, even if you have what passes for proof, sometimes health plans don’t care how right you are. (That, of course, is a story for another day!)

Ultimately, though, new data generates new ways of doing business. I believe that when doctors fully adapt to using wearable and app data in clinical practice, it will change the dynamics of their relationship with health plans. While sleep tracking may not be available in the near future, other types of sophisticated sensor-based monitoring are just about to emerge, and their impact could be explosive.

True, there’s no guarantee that health insurers will change their ways. But my guess is that if doctors have more data to back up their requests, health plans won’t be able to tune it out completely, even if their tactics issuing denials aren’t transformed. Moreover, as wearables and apps get FDA approval, they’ll have an even harder time ignoring the data they generate.

With any luck, a greater use of up-to-the-minute patient monitoring data will benefit every stakeholder in the healthcare system, including insurers. After all, not to be cliched about it, but knowledge is power. I choose to believe that if wearables and apps data are put into play, that power will be put to good use.

Look, Ma, no hands! EHR company drchrono is incorporating Google Glass in its platform. The idea is to create the first wearable health record -- one that is always mobile. Drchrono offers its EHR free on the iPad, iPhone and cloud. Adding Google Glass to its platform would enable physicians to work hands-free, its officials say.

"The iPad was a new consumption device that changed the world, and now we are seeing that doctors want to use more and more hands-free technology,” drchrono CEO and Co-Founder Michael Nusimow said, in a news release. "Glass is one of the first of its kind to do this. A physician wants to practice medicine and not be burdened with all of the paperwork that goes on in the practice. We knew this would be an important app to integrate into our EHR platform, and we're excited to now offer this to doctors using drchrono."

Nusimow imagines a future where the doctor has an iPad, iPhone, laptop and Glass all connected through a mobile EHR platform so they can operate efficiently and spend more one-on-one time with patients instead of processing paperwork.

Some use-case scenarios from drchrono:

Taking pictures in any setting by just saying, "OK, Glass, take a picture," e.g. during surgery a doctor can take a picture that will be pulled into the patient's medical record without his having to touch anything that could get his hands infected;

Recording videos of patient encounters or medical surgeries to document, so that medical staff and scribes can code in asynchronous time offline, and view the video to add codes after the encounter;

Real-time data streaming of patient encounters so that doctors can have other physicians, patients' family members, or scribes watching anywhere in the world while the physician can focus on the patient 100 percent;

Flipping through patient profiles on the heads-up display -- with the tap of a finger, physicians can quickly preview a list of all of the patients they are seeing for the day;

Getting real-time notifications about who has come into the office with alerts about patients coming in or needing help;

Reviewing medical data about patients hands free.

"This is a game-changing device," Bill Metaxas, DPM, who recently started using drchrono and Glass in his San Francisco practice, said in a press statement. "I am amazed at how well drchrono and Glass help the documentation process during patient encounters. It's a big time saver. I can see Glass becoming an integral part of the norm in a physician's workflow."

Drchrono is also expanding its platform integration with Box by enabling medical data captured with Glass to be available on Box's cloud content platform.

"Doctors want better workflow for capturing clinical documentation," Missy Krasner, managing director of healthcare and life Sciences at Box, said in a statement. "Glass provides faster alternatives to standard data collection and capture. By partnering with Box, drchrono can broaden its data-sharing options by allowing relevant medical content to be securely shared with patients, family members and other providers involved in patient care."

One day soon, you may be waiting in line for a coffee, eyeing a pastry, when your smart watch buzzes with a warning.

Flashing on the tiny screen of your Apple Watch is a message from an app called Lark, suggesting that you lay off the carbs for today. Speak into the Apple Watch's built-in mic about your food,sleep and exercise, and the app will send helpful tips back to you.

The notion of receiving nutrition advice from artificial intelligence on your wrist may seem like science fiction. But health developers like Lark are making a bet that Apple's first wearable device, the Apple Watch, will fly off the shelves and this kind of behavior will become the norm.

Lark is just one of over a dozen health developers with new apps for the Apple Watch, which ships to consumers this week. These apps range from medication management to a button that provides instant, virtual access to a doctor.

Apple has made no secret of its health and fitness plans for the Apple Watch. And in recent months, it has recruited medical experts to work on services like ResearchKit and HealthKit, which aim to open up the flow of health data between consumers, mobile developers and medical researchers.

But is Apple doing enough to protect the privacy of your sensitive health data?

In advance of the Apple Watch's release, the company has taken some steps to put you in control of how your data is shared. You can choose to share health information with third-party apps like Lark via Apple's Health app, which comes with the device. Your health data, collected via the Apple Watch or the iPhone, is stored on Apple's HealthKit.

"Apple is leaving your HealthKit data on the device and not collecting it," said Morgan Reed, executive director at The App Association, a Washington, D.C., nonprofit that works with patient advocates and app developers.

According to Reed, this prevents third-party app developers from selling your health data without your consent.

"It also means that if an employer wants access to your health care information, they would have to demand that you give it to them," he said.

But it's still early days for the Apple Watch, and it remains to be seen whether health developers will follow Apple's privacy guidelines.

"We haven't had a developer ecosystem for a product like a smart watch," said Ben Bajarin, who specializes in consumer technology for Creative Strategies, a consulting firm. "This is [uncharted] territory."

Imagine a doctor receiving a buzz on the wrist for an e-prescription request, which could be approved with a few taps. A patient could receive a similar alert when test results are available.

Developers are exploring these possibilities and more.

"We are predisposed to small changes on the skin. It was not that long ago — and is still the case in parts of the world — that mosquitoes used to kill us with a light touch," said Ron Gutman, chief executive of HealthTap, a website and mobile app for secure video calls with a doctor.

"It is so easy to turn off a notification from a website, but you can't ignore what's on your wrist," he said.

"Be prepared to take charge of your health information, and feel free to say no to sharing data with apps."

- Morgan Reed, executive director at The App Association

Managing Medications

For patients who are juggling a variety of meds — all with different dose requirements — an Apple Watch app that sends alerts to the wrist could prove useful.

WebMD, used by millions of people to check their medical symptoms, tossed around a bunch of ideas before settling on medication adherence.

"All we wanted is for the user to be reminded that it's time to take their medication, and then quickly tell us whether they plan to take it or skip it or snooze," said Ben Greenberg, who heads up WebMD's mobile products. "That interaction demands so little." The app also instructs people whether to take their medication with food, or at a certain time of day.

But the Apple Watch's appeal may be limited to certain specialties, such as family physicians and dermatologists. Surgeons routinely remove their rings and watches before procedures, to ensure their hands stay sterile.

Moreover, doctors will need to do the work to ensure that apps they use are taking adequate steps to protect patient data. Apps may say that they are meeting privacy requirements, but most aren't properly vetted. The government has long been concerned about the proliferation of mobile health apps that make false or misleading medical claims.

Opportunities And Challenges

Privacy experts and policymakers have been worried about developers that collect and sell personal health information.

The U.S. Federal Trade Commission concluded in a recent study that developers of 12 mobile health and fitness apps were sharing user information with 76 different parties, such as advertisers.

Apple has responded to some of these fears by barring developers from selling health data that it collects via Apple devices to advertisers. After some high-profile hacks to celebrities' accounts, Apple also forbade developers to store sensitive health information in iCloud.

"Apple has clear privacy rules, but consumers should still be on guard," said Reed from the App Association. "Be prepared to take charge of your health information, and feel free to say no to sharing data with apps."

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